Liaisons fuelling AIDS in Africa
Washington Times, Dec. 28, 2003

By Edward C. Green and John Berman

Teenage girls are at the very center of one of the most heart-
breaking scenarios now playing out in many parts of Africa.
Young girls have up to 6 times the rate of HIV infection as boys
of comparable ages. In parts of eastern and southern Africa,
more than one-third of teenage girls carry the virus.

As deeply troubling is the way they are becoming infected -
through what AIDS experts call "cross-generational sex." Older,
typically married, men seek young girls for sex in the belief
that the younger they are, the less likely they are to carry the
HIV virus.

Having a young girlfriend has come to be a sport, a way to gain
status among men. Cross-generational sex has become a new cul-
tural norm in parts of sub-Saharan Africa, and not just because
of one-time seductions or coercions. Sometimes it is the girls
who seek the "sugar daddies," who reward girls with clothes,
school tuition, food or small gifts.

One of many problems with this is that the younger the female,
the more biologically vulnerable to HIV infection she may be.
This seems to be due in part to the delicacy of the vaginal lin-
ing in immature females. Tiny tears and lesions occur during in-
tercourse, especially if male partners are full adults and/or
intercourse is coerced or forced.

Young girls are not only more likely to be HIV-infected, they
are also more likely to infect others, in part because they are
likely to be recently infected, meaning they will have higher
"viral loads" and will be shedding viruses. Their partners then
pass the virus on to their wives and perhaps future children.

Therefore, any action that protects girls from infection will
pay great lifesaving dividends in the broader population.

It's past time for our government leaders to get involved. The
cross-generational sex issue cuts across the politics of moral-
ity that color the current highly polarized debate on how best
to combat AIDS in Africa. Both faith-based organizations and
others who champion abstinence programs, and organizations well-
known for condom marketing like Population Services Interna-
tional, are in fact equally outraged by and concerned about
these dangerous relationships and their tragic consequences.

President Bush's global AIDS initiative will finally make anti-
retroviral drugs available in the countries targeted by this
initiative (all but two are in Africa). But there still needs to
be major emphasis on AIDS prevention, since many more lives will
be saved through effective prevention than through treatment.
Yet there cannot be effective prevention if we continue to tip-
toe around sexual behavior and simply rely on risk reduction
technologies.

We urge the Bush administration to include the prevention of
cross-generational sex as a central component of its AIDS ef-
forts, no matter how uncomfortable the idea makes some people.

Defenders of the current, unspoken hands-off policy worry that
we must not become "moralizers." Yet like it or not, rape, coer-
cion and seduction of minors take us into the realm of right and
wrong.

Ellen Goodman has wondered whether in the American transition
from a more religious to a more secular society, we have somehow
given ourselves a "moral lobotomy." She asks whether our reluc-
tance to being considered judgmental has "disabled [us] from
making any judgment at all." To advocate protection of highly
vulnerable young girls is not unwarranted moralizing. It is both
ethically right and life-preserving.

Changing sexual behavior is never easy, yet change is occurring
in some African countries, notably in Uganda, the country with
the greatest decrease in HIV infection rates.

Efforts must take place on at least three levels: individual,
social normative, and legislative. This translates into communi-
cations campaigns that stress abstinence (for youth) and faith-
fulness to one partner (for everyone else), and implementation
of a new generation of programs aimed at changing social norms
that perpetuate cross-generational sex.

Uganda has dealt with the "sugar daddy" phenomenon in part
through communications campaigns designed to bring public shame
on middle-aged men who try to seduce or entice schoolgirls.

Third, governments need to impose tough legal penalties against
statutory rape and seduction of minors. African governments al-
ready have legal prohibitions addressing this, but laws are sel-
dom enforced adequately. Yet in Uganda - prisons are filling up
with "defilers," the biblical sounding term used in Africa to
denote seducers of young girls.

On Capitol Hill, some lawmakers have a dawning awareness of this
dangerous situation, and briefings have already taken place with
staff from the offices of Sen. Richard Lugar, Indiana Republi-
can; Joseph Biden, Delaware Democrat; and Lamar Alexander, Ten-
nessee Republican.

We must keep up the momentum. It is critical that we hard-wire
the issue of cross-generational sex into the U.S. global AIDS
strategy. We must stop haggling over abstinence vs. condoms and
get on with the business of saving lives.

--
Edward C. Green, is a research scientist at Harvard University's
School of Public Health, author of "Rethinking AIDS Prevention,"
and a member of the Presidential Advisory Council for HIV/AIDS.
John Berman is senior director of the global AIDSMARK HIV pre-
vention program, managed by Population Services International.
He recently completed research on cross-generational sex in
Kenya.
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